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S5 PTA Special Topics > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q
  1. upper airway
  2. lower airway
  3. terminal airway
A
  1. upper airway: nasal cavity - pharynx - sinuses - larynx
  2. lower airway: trachea - bronchi - bronchioles
  3. terminal airway: alveoli
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2
Q

arterial blood gases

  1. PaO2
  2. PaCO2
  3. H+ (pH)
  4. H2CO3 (bicarbonate)
  5. O2 Sat
A
  1. PaO2: 75-100mmHg
  2. PaCO2: 35-45mmHg
  3. H+ (pH): 7.35-7.45mm/mL (acidity)
  4. H2CO3 (bicarbonate): 20-29 mEq/L
  5. O2 Sat: 95-98+% / chronic resp. illness > 86%
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3
Q

normal excursion of the chest wall

A
  1. inspiration: active muscle contraction (diaphragm & intercostals) - intra-thoracic volume increases - changes in pressure gradients - bucket handle (lower ribs) increases transverse diameter - pump handle (upper ribs) increases AP diameter
  2. expiration: passive recoil of lung structures (due to elastin) - intra-thoracic volume decreases
  3. forced expiration: rectus abdominus - internal and external obliques, TA
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4
Q

abnormal excursion of the chest wall

A
  1. disease of respiratory muscles: muscular dystrophy - SCI - polio - ALS - neuropathies
  2. rib cage movement problems: bony (kyphosis, scoliosis, trauma, ribs or thoracic fx) - pleural problems (infection, fibrosis, adhesions) - lung tissue problems (inflammation, infection) - altered abdominal motion (ascites, pregnancy)
  3. altered movement into alveoli: blocked or narrowed airways, broncho-constriction, excess secretions, obstructions and/or consolidations
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5
Q

common diagnoses

A

asthma - bronchitis - emphysema - COPD - cystic fibrosis - pneumonia - restrictive lung dysfunction
*non cardiac chest pain

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6
Q

pulmonary interventions

A
  1. airway clearance techniques
  2. breathing exercises
  3. exercise progressions
  4. patient education
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7
Q

airway clearance: secretion management

A
  • secretions = mucus, phlegm, sputum
  • normal adults produce ~1L mucus / day
  • mucus functions to trap foreign particles along with cilia that help to propel mucus/foreign particles back towards the upper airway to be expelled = mucociliary clearance
  • abnormal clearance = infection, respiratory exacerbations, decreased exercise/activity tolerance
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8
Q

secretion characteristics

  1. amount
  2. color
  3. consistency
A
  1. amount: normal (none/scant) or abnormal (measurable amount mL, tsp, or cups)
  2. color
    - red = blood
    - purple = neoplasm
    - yellow = infection
    - green = pus
    - pink = pulmonary edema
  3. consistency: thin/watery, thick, frothy, purulent (pus)
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9
Q

secretion removal techniques

A
  • postural drainage
  • chest PT
  • coughing/huffing
  • active cycle of breathing and autogenic drainage
  • breathing techniques
  • positioning
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10
Q

postural drainage

A

uses gravity and positioning to drain secretions from various lung lobes into larger airways to be expelled

  • lung segments are positioned 90degrees from horizontal
  • secretions are moved from peripheral to central airways
  • minimum of 10 minutes per position
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11
Q

contraindications to postural drainage (6)

A
  1. unstable head or neck injury
  2. recent spinal injury or surgery
  3. cranial hemorrage with ICP > 20 mmHg
  4. large pleural effusion
  5. pulmonary edema due to CHF
  6. PE
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12
Q

chest PT

A

use of mechanical energy through the chest wall to loosen airway secretions

  • manual: percussion, vibration, clapping, shaking, cupping
  • mechanical: high velocity chest wall oscillator, chest vibrators
  • can use in conjunction with postural drainage positions
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13
Q

contraindications for CPT (6)

A
  1. acute asthma attack or severe bronchospasm
  2. burns, open wounds, recent skin grafts, infection
  3. flail chest
  4. lung contusion
  5. osteoporosis/osteopenia
  6. osteogenesis imperfecta or other brittle bone disease
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14
Q

flail chest

A

occurs when a segment of the thoracic cage is separated from the rest of the chest wall

  • defined as at least two fractures per rib (producing a free segment) in at least two ribs
  • a segment of the chest wall that is flail is unable to contribute to lung expansion
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15
Q

positive airway pressure

A

splints the airways open during inspiration and/or expiration to prevent alveolar collapse

  • positive expiratory pressure (PEP)
  • positive end expiratory pressure (PEEP): 15min treatments performed in sitting
  • intermittent positive pressure breathing (IPPB): 15-30min treatments sitting or lying
  • continuous positive airway pressure (CPAP): short or longer durations, usually worn at night
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16
Q

cough characteristics

A
  1. dry: non-productive
  2. moist: productive or non-productive
  3. paroxysmal: sudden fit of severe coughing
  4. weak: usually without glottis closed and limited increase in intra-thoracic pressure
17
Q

huff

A
  1. inhale deeply through the mouth

2. forcefully and rapidly exhale while contracting abdominal muscles and say “ha ha ha” (glottis remains open)

18
Q

cough

A
  1. inhale maximally, close glottis and hold 1-2 sec
  2. high velocity maneuver with closed glottis after deep inspiration
  3. forces secretions out of large/upper airways
  4. repeat 2-3x
19
Q

active cycle of breathing (ACB)

A

used for breathing control, thoracic expansion, and forced expiration

  • normal relaxed breathing at pt’s own tidal volume x 5-10sec or 2-3 cycles
  • SLOW deep breathing to maximal volume, with passive exhalation x 3-4 cycles
  • 1-2 huffs at mid-low tidal volume
  • brisk adduction of upper arms to torso to self compress the chest/thorax with exhalation
  • normal tidal breathing can be added as needed between steps
20
Q

autogenic drainage

A

cyclic breathing that “milks” secretions from smaller to larger airways

  • ACBT performed with huffs at low lung volumes
  • ACBT performed with huffs at mid lung volumes
  • ACBT performed with huffs at high lung volumes
21
Q

apnea

A

absence of breathing

22
Q

tachypnea

A

fast RR, decreased depth (shallow)

23
Q

bradypenea

A

slow RR, increased or normal depth

24
Q

orthopnea

A

difficulty breathing in positions other than upright/erect

25
Q

cheyne-stokes

A

alternating bouts of increased RR and apnea

26
Q

dyspnea

A

shortness of breath

27
Q

breathing techniques

A
  1. diaphragmatic breathing
  2. inspiratory muscle re-training (IMT)
  3. paced breathing and exhale with effort
  4. pursed ip breathing (PLB)
  5. segmental breathing
  6. incentive breathing
28
Q

paced breathing with activity

A
  • inhale before or during “easier” parts of an activity
  • exhale upon exertion/effort
  • breaks activity up into slower tempo/manageable intervals
  • avoid valsalva or holding breath
29
Q

pursed lip breathing (PLB)

A
  • breathe in slowly through nose for 2 counts
  • pucker your lips as if you were going to whistle
  • gently and slowly exhale as if you were trying to make a candle flicker for 4 counts
  • creates a relaxing effect
  • assists with emptying of lungs
30
Q

segmental breathing

A
  • localized breathing or thoracic expansion
  • position patient as indicated: PD positions may be used
  • therapist places hand on area to be expanded: have pt breath into hand (minimal to no force applied)
  • on exhalation: therapist applied firm pressure to area at the end of exhalation
  • can add a quick stretch at end of exhalation if indicated
31
Q

incentive spirometry (sustained maximal inhalation)

A
  • sit or lie upright in a comfortable position
  • hold incentive spirometer upright with both hands
  • slide indicator to desired level and slowly raise it as pt improves
  • with lips tightly sealed around mouthpiece, breath in slowly and deeply
  • hold breath for at least 3 sec and let piston fall back down
32
Q

exercises for chest wall expansion

A
  • pectoralis and cervical stretches
  • shoulder ROM activities
  • postural muscle strengthening and re-education
  • PNF (D2)
  • foam roller
33
Q

aerobic exercise prescription

A
  1. mode: rhythmical activities using large muscle groups, better with total body activity, performed continuously
  2. intensity: THR 55-90% depending on variety of factors
  3. duration: 20-60min or 10min bouts cumulatively
  4. frequency: 3-5x/wk
34
Q

pulmonary symptom aggravatros

A
  • anything that increases work of breathing
  • pain
  • edema (pulmonary)
  • anxiety/stress/fear
35
Q

pulmonary symptom alleviaters

A
  • secretion removal, breathing techniques and positioning
  • reassurance and relaxation
  • offer oxygen and/or bronchodilator if prescribed by MD
  • splinting or supportive overpressure
  • pacing, activity modification
  • education
36
Q

oxygen

A
  • MD prescription
  • dosage in L (2L O2 via nasal cannula)
  • titration: ability to change to dose (titrate to 90% O2 sat)
37
Q

tools to assess efficacy of treatment

A
  • ausculation
  • pulse ox
  • sputum production
  • dyspnea rating (borg, RPE)
  • functional and exercise tolerance tests
  • observations
  • compare pre and post treatment

S5 PTA Special Topics (13 decks)

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